INQRI Study: Nurses Experience Depression at Twice the Rate of General Public

July 25, 2012

One person’s depression rarely takes a toll on that person alone, since ripple effects of the disease are often felt by family members, friends and coworkers. And when nurses suffer from depression, it’s no surprise to find that it may affect their work and their patients.

A recent study funded by the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative (INQRI), reveals the extent of the problem, finding a depression rate among nurses—18 percent—that’s double the rate for the general public, and exploring the potential impact on coworkers and patients.

Depression in nurses and treatment options were the focus of “Depression in Hospital-Employed Nurses,” published in the May/June issue of Clinical Nurse Specialist. These findings were part of a larger study on “presenteeism”—when nurses come to work despite personal health problems—and musculoskeletal pain, which is closely related to depression in the context of presenteeism and its impact on productivity and the quality of patient care. That study was published in the February issue of the American Journal of Nursing.

According to the most recent article, depressed workers often exhibit low mood, have difficulty concentrating and are accident-prone; additionally, they have limited ability to perform mental or interpersonal tasks, struggle with time management and have lower total output than nondepressed workers. Hospital nurses with depression, therefore, are not only likely to suffer individually, their illness is likely to have an adverse impact on their coworkers and, potentially, the quality of patient care.

The research team behind the study consists of Susan Letvak, PhD, RN, associate professor of nursing, the University of North Carolina at Greensboro, School of Nursing; Christopher J. Ruhm, PhD, professor of public policy and economics, the University of Virginia, Department of Economics; and Thomas McCoy, MS, and Sat Gupta, PhD, statisticians at the University of North Carolina at Greensboro.

Coverage of the study includes an interview with Letvak in the New York Times and on “The Conversation,” a program featured on NPR affiliate KUOW in Seattle. “The only way to ensure the best quality for our patients is to have an expert staff of qualified nurses who are healthy enough to offer that kind of care,” Letvak told the New York Times. “We can’t ignore nurses’ health anymore.”

The researchers analyzed surveys from 1,171 hospital nurses in North Carolina to determine the prevalence of depression and to determine individual and workplace characteristics that are associated with the illness. They also concluded that advanced practice nurses are uniquely positioned to recognize depression in staff nurses and offer them confidential and accessible treatment options.

Depression was measured by the PHQ-9, a nine-item self-reporting tool developed for use in primary care. Among individual variables, several emerged as having a significant relationship to a higher total depression score: body mass index (BMI), job satisfaction, number of health problems, mental well-being and health-related job productivity.

“Depressive symptoms affect enough nurses to warrant concern and intervention, and high-stress environments are likely to contribute to more health problems for nurses, including mental health issues, which are less likely to be disclosed that physical problems,” Letvak said.

It is imperative to devote more attention to depression screening and early treatment, the research team points out. Advanced practice nurses can educate the staff nurses they work with about the high prevalence of depression in nurses, who, like the general population, may be reluctant to get screening and treatment, due to the social stigma attached to mental illness.

The researchers identify Web-based screening as a confidential and cost-effective means of reaching the nursing population, and they recommend that clinical nurse specialists inform nurses about options for computerized cognitive-based therapy, which removes treatment barriers such as stigma, time constraints and cost. Other strategies for assisting nurses with depression include increasing staff nurses and managers’ awareness of and sensitivity to depression, advocating policies that support good mental health and treatment for those with problems, promoting supportive work environments and making reasonable accommodations for nurses whose depression is negatively affecting their work performance.